Highlights Of Dr. Mostashari First Speech Since Stepping Down As ONC Chief

Dr. Farzad Mostashari didn’t quite bare his soul to a bunch of hospital CIOs, but the man who was indefatigably buoyant as the nation’s federal health information technology czar did pull back the curtain a bit and offered an assessment of his own concerns as well as some “insider clues” in his first speech since leaving federal service.

Mostashari stepped down as head of the Office of the National Coordinator for Health Information Technology on Oct. 5.

He announced last week that he’d be joining the Brookings Institution, a Washington think tank, working for its Engelberg Center for Health Care Reform.

“I’m hopeful and optimistic, but in terms of having new technologies and systems, I’m a little concerned,” Mostashari said.

And now, speaking “not as national coordinator,” he shared some of those concerns about both the current state and the future of healthcare IT.

“Too many don’t know how to do this,” Mostashari said, meaning the needed, technology-enabled changes in healthcare delivery.

Healthcare organizations can buy population management software, “but flipping the practice, flipping the hospital, so that everything doesn’t take place in an eight-minute visit, that’s a cultural challenge. It’s not an IT challenge; it’s a business practice challenge. And we have providers who are struggling with the pace of change. We all are, but the front-line provider, there is more and more being placed on them.”

“I do worry about usability,” Mostashari added, referring to the oft-aired complaints that today’s EHR systems are hard to navigate, slow providers down and interfere with the physician-patient relationship.

“Not that it (usability) isn’t getting better,” Mostashari said. “It is getting better. But the expectations are rising even faster. I didn’t think there is a clear government role as there is a market role, but I wonder if the market is incentivizing usability as much as it should.”

Poor communication across the industry is another concern, he said, and wondered aloud about how much time “is being spent on things others have already done.”

Innovations and best practices need to be better shared, Mostashari said. “Everyone re-discovering the same thing is not necessary.” Healthcare IT people need to “find ways to sustain information sharing. It just doesn’t feel we’re having enough of that happening to get us through this next period.”

He also dropped “a couple of insider clues” as to the policymakers’ perspectives on calls for delaying Stage 2 of the federal EHR incentive payment program under the American Recovery and Reinvestment Act.

“There is no legal way to change the final rule without a pretty elaborate process that takes nine to 12 months,” he said. Instead, Mostashari said, CHIME and others pressing for relief from penalties for noncompliance might look to “sub-regulatory guidances.”

“There is the ability in the rule for hardship exemption,” Mostashari said. “You wouldn’t get the payment, but you wouldn’t get the penalty. That’s where I would advise CHIME to look.”

Besides, Mostashari said, without the technological leap required in the upgrade to the so-called 2014 Edition tested and certified software (providers must use the 2014 systems for both Stage 2 and, some, for Stage 1) other programs that depend on interoperability are jeopardized.

“We can’t wait for interoperability,” he said. “You all know this. It’s past time. We have a series of really, really important standards” baked into the 2014 Edition criteria. “I think folks should assume the timelines will stick.”

CHIME President and CEO Russell Branzell asked Mostashari to recall during his four-year stint at ONC, including more than two years as its leader, what was his proudest moment.

There was a long, silent pause.

“One moment does stick out,” he said. It was at a “town hall” meeting at another convention when David Muntz, a CHIME member and the former principal deputy director of ONC; Joy Pritts, chief privacy officer, Jodi Daniel, director of policy and planning, and other top ONC leaders, were all assembled on the dais.

“You just looked up there and (saw) person after person who really knows their stuff, and all of them had been out there in the field and probably could have done other things, but they chose service, and the crowd really appreciating them for their service. That was my proudest moment,” he said.